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REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH- II)

REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH- II). Commemoration of 5 years of NRHM Amit Mohan Prasad, JS 13 th April 2010. CURRENT STATUS VIS-À-VIS RCH II/ NRHM GOALS. MMR…we need to accelerate pace of decline. Maternal Mortality-Magnitude and Causes.

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REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH- II)

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  1. REPRODUCTIVE & CHILD HEALTH PROGRAMME, PHASE II (RCH- II) Commemoration of 5 years of NRHM Amit Mohan Prasad, JS 13th April 2010

  2. CURRENT STATUS VIS-À-VIS RCH II/ NRHM GOALS

  3. MMR…we need to accelerate pace of decline

  4. Maternal Mortality-Magnitude and Causes About 28 million pregnancies and 67,000 maternal deaths per year in India * Other Conditions includes Anemia. Source: RGI-SRS 2001-03

  5. MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… • Maternal death caused due to three delays: • Delay-1: Delay in decision-making • Delay-2: Delay in reaching the hospital • Delay-3: Delay in initiating appropriate care

  6. MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… Delay in Decision making • Issues: Lack of awareness, financial constraints, etc. • Intervention: • Awareness and counselling through ASHA, ANM, and AWW • Availability of finance through JSY for institutional delivery • Availability of services at the village through Village Health & Nutrition Days (VHNDs) – 58.17 lakh VHNDs held during 2008-09; and 44.33 lakh during 2009-10 (till January 2010). • Skilled providers for domiciliary birth

  7. MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… Delay in reaching the hospital • Issues: Lack of knowledge about danger signs, and availability of transport facilities • Intervention: • Orientation and counselling on danger signs through ASHA, ANM, and AWW • Availability of finance for hiring vehicle through JSY • Availability of referral services through EMRI, government ambulances, and other PPP arrangements

  8. MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… Delay in initiating appropriate services • Issues: Availability of operational facilities for tracking pregnancy and its complications • Intervention: • Upgradation of infrastructure at the district level and conversion of nearly 2500 CHCs to FRUs • Multi-skilling of doctors to overcome shortage of critical specialties • 1024 doctors trained in anaesthesia skills and 543 doctors trained in obstetric skills for handling pregnancies and their complications • 37162 staff nurses/ LHVs/ ANMs trained as skilled birth attendants

  9. MATERNAL HEALTH • MMR seen as the indicator of health of the health system • Emphasis on early registration • Full complement of Ante natal check up can help in identifying high risk pregnancies in time • Operationalize VHND for ANC, PNC and Nutritional supplementation • Some states trying Iron Sucrose injection this year

  10. MATERNAL HEALTH • JSY reached the 1 crore (provisional) mark during 2009-10 • Pregnant woman and child tracking system rolled out • Common MCH card for MOHFW and MWCD designed and rolled out for the first time • AMTSL being tried out in the high burden districts

  11. MATERNAL HEALTH STRATEGIES (contd..) • Comprehensive safe abortion services • Guidelines released on April 12, 2010 by Hon’ble Vice President of India • May be taken up by States on priority to ensure training of personnel, and provision of services at health facilties • Maternal Death Review • Guidelines for facility based maternal death review and community based verbal autopsy, already shared with the States last year • May be taken up on priority (several states have proposed in current PIP  may ensure adherence to GoI protocols)

  12. CHILD HEALTH & IMMUNISATION

  13. Need to accelerate IMR reduction IMR

  14. Uttar Pradesh Bihar Gujarat Maharashtra Tamil Nadu Kerala

  15. Need to accelerate NMR reduction

  16. Neonatal Deaths INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD DEATHS Under-5 Child deaths

  17. CHILD HEALTH • Need to focus on neonatal and early neonatal mortality • ToT of NSSK has been rolled out very fast. • States need to plan and set up SNCUs, Child Stabilization units and Newborn corners • Time to look at Birth Defects like cretinism, neural tube defects, cleft lip/palate etc.

  18. CHILD HEALTH • 3 Delays are important in this context also • Part of VHSC money can be effectively utilised for arranging referral transport for sick child • Block PHC level supervisors and ANMs to monitor the implementation of IMNCI • Central hand holding teams prepared

  19. Other key child health interventions • School Health Programme running across all States / UTs; nearly 45% of all school-going children (9.5 crores out of 22 crores) covered during Apr-Nov 2009. • A national workshop on School Health is being organised on May 6-7, 2010 • 638 Nutrition Rehabilitation Centres established so far, to handle severe acute malnutrition among children. • A session on NRCs also will be there on 6th May

  20. Sick Newborn Care Units (SNCUs)

  21. Initiatives for improving RI service delivery • One of the key components of VHND • Role of ASHA is critical – maintaining immunisation due list; informing beneficiaries in advance; mobilising beneficiaries on VHND; track drop outs • Name based tracking of children for immunisation initiated – joint MCH card developed with MoWCD; States may coordinate with their WCD depts. to ensure that a uniform card is used • All vaccines are provided through AD Syringes • All vaccines vials have Vaccine Vial Monitors • Provide easy sign of a break in the cold chain  loss of potency • Alternate vaccine delivery • Rs 50/- per session in all States for alternate vaccine delivery • For NE states and Hard-to reach areas in other states - Rs 100/-per session is being provided • Alternate vaccinators for urban slums & underserved areas • Capacity building of all immunization staff • Improve supervision through mobility support and regular review meetings

  22. Fully Immunized Children (12-23 mo) India: DLHS DLHS-III (2007-08) 54.1% DLHS-II (2002-04) 45.9 Source: http://www.mohfw.nic.in/dlhs/dlhs08_release_1.htm

  23. Coverage of Universal Immunization ProgramDLHS3(2007-08) Source: District Level House hold Survey 2008

  24. Reaching the Last Mile Govt. of India State/UT Divisions /Districts Flow of Funds, Vaccines & Logistics from GoI to PHC/CHC CHC/PHCs Vaccines by Alternate Vaccine Delivery Community Mobilization by ASHA Vaccination by ANM Session Village Sub-centre

  25. Status of AEFI Committees State Level District Level N=35 N=494 ~80% district in India have constituted District AEFI committee (as on 15th Mar 2010) Source : As per available records with MOHFW, GoI

  26. Second Opportunity for Measles Immunisation • National Technical Advisory Group on Immunization (NTAGI) recommended for 2nd Opportunity for Measles vaccination through • Supplementary Immunization Activities of Measles where measles coverage <80% • 14 States identified for SIA (NE State except Mizoram, UP, Bihar, MP, Rajasthan, Chhattisgarh, Gujarat, Haryana, Jharkhand) • 2nd dose of Measles where measles coverage >80% • 21 states identified for 2nd dose of Measles (Rest of the states)

  27. Vaccine & Logistics flow in the country Manufacturer State cold chain store 35 nos WIF 19 nos(7NCFC) in 13 states WIC 37 nos (11 NCFC) in 28 states GMSDs 4 nos (Only buffer Stock & imported Vaccines) WIFs 9 nos (9 NCFC) WICs 8 nos (2 NCFC) Identified Regional Store 20 Nos WIF 10 (3 NCFC) WIC 20 (5 NCFC) Divisional cold Chain stores 96 nos WIC 96 nos Beneficiaries CHC/PHC 26439 nos ILR (S) 35713 (20229 NCFC) DF (S) 25063 (12491 NCFC) Sub-centers/ sessions sites Districts stores (618 nos) DF (L) 3221 (2223 NCFC) ILR (L) 2680 (1999 NCFC)

  28. Cold Chain Monitoring By MOHFW: All CC Equipments procured and supplied to the states. Cold Chain maintenance fund to the states @ 500/- per PHC & 1000 per district. All imported spares are being provided. On the job training for the repairs of cold chain equipments to the refrigerator mechanics of the states, out of 405 Ref. Mechanics, 393 RMs trained since 2007 Technical support for maintenance of cold chain. By states: Cold chain officers at state head quarters. Total 22 nos CCO posted. SEPIO working as CCO in 13 states 405 refrigerator mechanics posted in the states to maintain the cold chain equipments. Indigenous spares being procured by the states. Periodical cold chain handlers training.

  29. Cold Chain: Key issues Most cold chain rooms are old & substantial up gradation is required. Installation of new WIC/WIFs – space allocation. Total 91 WICs and 25 WIFs have already been send to the states. The installation team will be visiting states after 15th April 2010 but in many states the site of installation is not ready. The delay in installation will leads to deterioration of new equipments. A large part of the cold chain equipment (45%) in the country is currently operating on obsolete CFC refrigerant. High sickness rate, response time and break down period of cold chain equipments. Temperature monitoring of cold chain equipments requires strengthening Cold chain management is poor in some places (including private practitioner), particularly for temperature recording and risk of freezing the freeze-sensitive vaccines. There is need to assess adequacy of trained manpower with essential qualifications at every level. Disposal of condemned equipments – occupying un-necessary space. Needs to be dispose off on priority basis

  30. Estimated Polio Cases/year, India PPIs started in 1995 OPV introduced in RI in 1978 PPIs strengthened

  31. FAMILY PLANNING

  32. Family Planning Services • Improved sterilization performance – 50 lakh plus cases • Increasing service provider base • NSV trained – 4562 • IUCD insertion trained – 19021 • Compensation package for NSV revised to Rs. 1500 • Family Planning Insurance operationalised. • ASHAs as depot holders of contraceptives. • Focus on spacing methods and Post Partum Family Planning services • Improving quality of services through Quality Assurance Committees at state and district level

  33. Family Planning Services (contd..) • A National Workshop is being organised on May 5, 2010, bringing together key stake holders and reknowned persons • A list of MLAs, MPs and Zilla Parishad CEOs was requested from the States, for targeted action for FP advocacy • Incentive being considered for ASHA for follow up of IUD insertion to ensure retention • Rs. 50 at the end of 3 months if client retains the IUD • Rs. 50 at the end of 6 months if client retains the IUD • Payment linked to confirmation of the retention of the IUD by the client, by the sub-centre ANM or the MO I/c (PHC)

  34. FAMILY PLANNING • Need to bring it back into focus • Family Planning for Maternal and Child health also in addition to Population Stabilization • JSY+ initiative: post partum counseling • TOT on Zoe model • National Workshop on the 5th of May

  35. TO SUM UP • Continuous focus on the reduction of IMR, MMR, TFR • Neonatal mortality, Immunisation coverage, Anemia and malnutrition require focus • Numbers achieved, quality of care remains • Infrastructure --- SNCU, Blood Storage Unit, Maternity Wards, ASHA rooms • Trainings and rational deployment

  36. We are committed to achieve the MDGs Countdown to 2015 begins……..

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